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A curious surgical case

In 1846 John Kyle, a surgeon from the Ohio village of Cedarville, submitted the following case report to The Western Lancet. The headline gives some indication of the unusual nature of the circumstances:

In the spring of 1846 I was called to see — Moore, a boy aged 2 years. He had been a very strong, healthy and fleshy child; now weak, much emaciated and suffering great pain in the bowels.

The doctor noted that the boy’s face was pale, his extremities cold, and he had no appetite. His abdomen was tender, and there was a curious ridge-shaped swelling which ran from one side to the other of his belly,

with the appearance of pointing at the extremity of the swelling on the right side, as if some foreign body was trying to make its way out, being as yet, however, rather uncertain what direction it should take, in order to reach its intended destination.

Not at all sure what he was dealing with, Dr Kyle asked the boy’s parents what had happened.

Fourteen days previous to that time, the boy was badly choked by something, which after some considerable difficulty he swallowed. After which his parents noticed nothing peculiar for two or three days, when he became fretful and peevish, lost his appetite, and had pain in his bowels.

Thinking the child had colic, his parents gave him tonic medicines and laxatives, without success. When his symptoms became more serious they had decided to seek medical attention.

The history of the case, with the then present symptoms, led me at once to conclude that the boy had swallowed some solid indigestible substance, and it having become entangled in some fold of intestine, had passed through its coats and was now pointing to the surface, and that an operation would be necessary to relieve the boy.

The parents were dubious about this prospect – it was 1846, after all, an era when anaesthetics were unknown in most of America. After a night spent agonising over the decision, they finally agreed to let Dr Kyle operate. The boy’s condition had deteriorated overnight, making the need for intervention all the more urgent.

The boy being secured, I made an incision ten lines long about equidistant from the umbilicus and anterior superior spinous process of the right ilium cutting carefully through the integuments and abdominal muscles.

A line is a twelfth of an inch. The doctor’s incision, on the right side of the abdomen, was tiny – just 2 cm.

A foreign body could now be felt under the peritoneum, which I punctured with a sharp pointed bistoury.

The peritoneum is the membrane covering the abdominal organs.

This brought to view a brown corn straw, which I seized with a small pair of forceps and drew out, applied simple dressings, the wound healed by the first intention, and the boy regained his health in a short time. The corn straw was forked near the middle, measured 33 lines in length, one in diameter, and at the fork nearly 3 lines across. It had evidently been swallowed by the boy 15 days previous to the operation.

The doctor does not explain which part of the bowel the straw had punctured. Also notable is the fact that he made no attempt to repair the site of the puncture. This may have been a good thing: handling the injured bowel would have been a recipe for infection. Nevertheless, the boy seems to have been incredibly lucky that the injury healed of its own accord – if the intestine had leaked even slightly into the abdominal cavity his chances of survival were slim.

The novelty of the operation, the causes which led to it, and the happy result of the same, are the only apologies the writer has for thus making this case known to his professional brethren.

The surgeon makes this procedure sound almost mundane, but it was far from that. Removing foreign bodies from the bowel in 1846 was no small undertaking.